Ask Dr. Doug: Missing Sweet Slumber
Q: We recently had our first baby, and while those first weeks were hard, she was sleeping for five- to six-hour stretches at night by the time she was 3 months. She’s 4 months now, and now she’s waking up every two to three hours again. Is this the dreaded 4-month sleep regression? What should we do?
A: Sleep issues are one of the most common questions I tackle in my practice, and for good reason. A good night’s rest is essential to not just feeling functional the next day for us as parents, but for overall health, brain development, and growth for our kids.
What you’re describing is 100 percent normal, and is based on how sleep changes in babies as they grow. Newborns spend their sleep time between active sleep (REM sleep) and quiet (deep) sleep. But at around 4 months, their sleep phases become more like ours — light sleep, down into deep sleep, then up into dreaming sleep for a sleep cycle. This means 4-month-olds spend much more time in light sleep, with more chances to wake up during the night. Some babies put themselves back to sleep without a peep, but most don’t!
If babies are used to falling asleep a certain way, when they come up to light sleep, they want those same conditions recreated. This is called a sleep association. The analogy I like to use is if we went to sleep in our beds and woke up at 2 a.m. on the living room floor, we wouldn’t just roll over and go back to sleep (well, maybe we would as sleep-deprived parents). In the same way, if babies fall completely asleep while nursing, or while being rocked, often they’ll wake more at night and need our help getting back to sleep.
Four- to 5-½-months-old is a perfect time to make sure your bedtime routine is consistent and predictable and to work on sleep associations at bedtime. Try to get your baby down where you want her to sleep for the night (while sleepy, but still a bit awake), so she can feel comfortable falling asleep on her own. Often bedtimes naturally move earlier at this age, too. If she is rolling consistently, you need to wean her out of the swaddle. This can be its own challenge, but there are lots of transitional swaddles to try that may help.
Please remember the safest sleep environment for an infant is a flat, firm surface next to your bed, with no blankets or soft bumpers.
Keep in mind there is no one off-the-shelf solution for sleep problems at each age. Be sensitive to your routine, your goals, and your child’s temperament. Some babies are laid back and regardless of what we do, they’ll progress towards longer and more independent sleep. Some are a bit less into the whole nighttime thing, and you’ll need to adjust accordingly.
And please don’t be shy about bringing up sleep issues with your pediatrician. My goal is always to take care of the whole child, and I frequently spend entire visits just focused on sleep. Here’s hoping for more sweet slumber for your little one!